Velocity Volunteer Application Form

REAL Life Community Services Velocity Lead Mentor Application.

Personal Data

Name

This address will receive a confirmation email

Cell Phone

Physical Address

Date of Birth

Sex

Please select one option.

Male Female

Marital Status

Please select one option.

Single Married Divorced Separated Widowed

Emergency Contact Name

In case of Emergency, call

Education

Highest Amount of Schooling Achieved

Please select one option.

8th grade High School GED Technical/Training program Associates Degree Bachelors Degree Masters Degree Doctorate

Employment

Employment Status

Please select one option.

Employed Full time Employed Part Time Unemployed Retired

Employer

Occupation

How long have you been employed?

Legal

REAL Life Community Services requires that all staff and volunteers have current PATCH and CAC forms on file with our offices. These need to updated every 5 years. There is no charge if you are a volunteer.

PATCH - Pennsylvania Access to Criminal History (free) https://epatch.state.pa.us/

CAC - Child Abuse Clearance (free) http://www.compass.state.pa.us/cwis/public/home

Child Abuse Clearance

Upload (8MB)

Criminal History

Upload (8MB)

Notes

Community Involvement

Are you associated or do you attend any church?

Please select one option.

Yes No

If so, which congregation do you attend?

Volunteering

I hereby certify that I am in good physical condition to participate in the volunteer program with REAL Life Community Services. I will not hold REAL Life Community Services or the location where I am serving responsible for any accidents, injuries or losses of property.

Signature & Date

Availability

Please mark the times when you would be willing to serve. Velocity will meet Tuesday evenings for 2020, but may adjust their schedule in the future to fit in with Cocalico School District's schedule.

Evenings

Please select all that apply.

Mondays Tuesdays Wednesdays Thursdays Fridays Saturdays

Why do you wish to be a part of Velocity - Cocalico?

What experiences or skils do you have that make you a good Lead Mentor?

Describe a time when you overcame adversity in your life.

Who do you look up to and why?

What superhero power would you like to have and why?

Description

REAL Life Community Services Velocity Lead Mentor Application.

Velocity Volunteer Application Form

Description

Please Fix the Following